Double Pigtail to Manage Pericardial Rupture of Left Lobe Liver Abscess

Abstract

Background: Liver abscess if left untreated can rupture into adjoining pleura, pericardium, peritoneum. Rupture into pericardium, though very rare, is a dreaded complication and worsens the prognosis. Presentation here can be nonspecific. Rupture into pericardium if associated with cardiac tamponade often requires pericardiotomy. Case information: A 16-year boy presented with epigastric pain, fever and recent onset chest discomfort. No signs of cardiac tamponade were seen on clinical examination. Investigations revealed a left lobe liver abscess rupturing into pericardium and asymptomatic pericardial effusion. Serological testing confirmed the etiology to be amebic. The condition was using pigtail catheter drainage in both the pericardial cavity and hepatic abscess. Discussion: Ruptured liver abscess occurs more commonly due to delay in diagnosis. It increases the severity of disease depending upon the site of rupture. Pericardial rupture is the most feared complication out of these. Published literature lacks reports of asymptomatic pericardial rupture of liver abscess, and management options. Available literature reports invariable requirement of surgical drainage for this entity. This report shows that lesser invasive drainage procedures can successfully resolve this dreaded complication. Conclusion: Amoebic liver abscess rupturing into pericardium can be asymptomatic. Successful management with percutaneous drainage and double pigtail catheters offers resolution and avoids morbidity associated with surgical drainage.